There are many stages of breast reconstruction, first the breast mound is created with a flap or implant. Then the nipple and areola are made, and often revisional contouring is done with fat grafting.
Post mastectomy reconstruction with a tissue expander and implant involves stages. A tissue expander is a temporary device that is placed on the chest wall deep into the pectoralis major muscle. This may be done immediately following the mastectomy, or as a delayed procedure. The purpose of the expander is to create a soft pocket to contain the permanent implant. Tissue expanders are available in a variety of shapes and sizes.
Once expansion is completed and the patient is medically cleared for another operation (about one month after chemotherapy), the second stage of reconstruction is performed. This is an outpatient procedure that involves exchanging the expander for an implant, and creating a more refined breast shape.